Intravascular ultrasound guidance for percutaneous coronary intervention in the current practice era

Coronary angiogram, considered the gold standard for coronary assessment, consistently underestimates vessel size/lesion severity and usually misses heavily calcified plaques. Intravascular ultrasound (IVUS) technology accurately determines vessel size/lesion severity and allows a detailed plaque composition evaluation. The role of IVUS guidance after stent implantation has been explored in various trials; however, limited data are available on how the preprocedural use of IVUS might impact the intervention strategy and clinical outcome. Based on the latest published evidence and in our own experience, we support a more liberal use of IVUS, especially when approaching complex coronary lesions, thereby resulting in an optimal interventional result that might affect clinical outcome.